Trends in microbiological spectrum of endophthalmitis at a single tertiary care ophthalmic hospital in India: a review of 25 years

Abstract

Purpose To determine trends in the microbial spectrum of endophthalmitis over the past 25 years and to review its antibiotic susceptibility patterns over the last 10 years. Methods Microbiology records of culture-positive endophthalmitis cases from 1991 to 2015 were reviewed. Additionally, data between 2005 and 2015 was also analyzed for trends in antibiotic susceptibility. Results Of the total of 9278 patients, 3319 (35.7%) were culture positive and included bacteria (2840/3319, 85.56%), fungi (387/3319, 11.66%), and mixed cultures (92/3319, 2.7%). Gram-positive bacteria accounted for 67.68% (1922/2840) of the total bacteria seen, with the most prevalent pathogen being Streptococcus pneumoniae and Staphylococcus epidermidis. Among the gram-negative organisms Pseudomonas aeruginosa was the most prevalent while. Aspergillus flavus was the most common fungus isolated and Candida sp. accounted for 6.9% of the total fungi isolated. There was no significant change in the trends of bacteria isolated during the study period. Overall susceptibility patterns showed that gram-positive bacteria were most susceptible to vancomycin (96%) and fluoroquinolones (89%). The resistance to ceftazidime increased from 31% in 2005 to 62% in 2015 (P = 0.006) and amikacin decreased from 36% in 2005 to 33% in 2015 (P = 0.782). Although a significant trend (P < 0.001) toward increasing microbial resistance against cephalosporins and fluoroquinolones was observed, decreasing microbial resistance against glycopeptides and aminoglycosides was also detected. Conclusion The spectrum of pathogens causing endophthalmitis at our institute remained similar over the study period. These findings impact the empiric treatment and choice of antibiotics in patients with endophthalmitis.

Pathobiology of Aspergillus Fumigatus Endophthalmitis in Immunocompetent and Immunocompromised Mice

“…Since most data on Aspergillus endophthalmitis are limited to clinical and epidemiological studies [19,20], the molecular pathogenesis of this disease is not well understood. This, in part, could be due to limited or unavailability of appropriate fungal endophthalmitis animal models.…”

<p>Clinical Presentations and Comparative Outcomes of Delayed-Onset Low-Grade Endophthalmitis Managed with or Without Intraocular Lens Explantation</p>

“…We have shown the reducing culture positivity over the past 25 years and it could be as low as 35%. 15 The rate of positive culture was higher in the group where the IOL was explanted. This could be due to the fact that the explanted IOL was directly inoculated into the agar plate in the operating room.…”

Microglial Response to Aspergillus flavus and Candida albicans: Implications in Endophthalmitis

“…remain the predominant cause of fungal endophthalmitis worldwide, in tropical countries such as India and China, Aspergillus spp. are the leading etiological agent of exogenous endophthalmitis [13]. However, the pathogenesis of Aspergillus endophthalmitis is not well studied, baring a report to evaluate the therapeutic efficacy of existing and newer antifungal agents in the eye of an animal model of A. fumigatus [24].…”

“…However, the pathogenesis of Aspergillus endophthalmitis is not well studied, baring a report to evaluate the therapeutic efficacy of existing and newer antifungal agents in the eye of an animal model of A. fumigatus [24]. Keeping our focus on A. flavus, which has been described by us earlier as the most common etiology in our country [3,13], our study, for the first time, used microglia cells as a model for fungal endophthalmitis.…”

“…Understanding the available information on how microglial cells react and influence disease progression in fungal infections is important and warrants further investigation to mitigate the number of clinical cases of patients with fungal endophthalmitis not responsive to standard therapy [12]. Additionally, a previous 25 year study at our institute found the filamentous fungus Aspergillus flavus (A. flavus) as one of the most clinically relevant fungal pathogens [13] which is a less studied organism compared to its related and well known human pathogen, A. fumigatus [14][15][16]. The purpose of the present study was to study the hypothesis that microglia cells would have a differential inflammatory response to infection by C. albicans and A. flavus isolates.…”